Employed or Self-employed: Did You Make the Right Choice?

Leigh Page

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October 12, 2016

In This Article

Employed Physicians and the Problem of Disengagement

Even working in a small group of physicians means giving up some autonomy, according to Sharam Danesh, MD, a solo ophthalmologist in Phoenix.

Before starting his solo practice, Dr Danesh was employed by a group of eight physicians and never chose to become a partner, striking out on his own in 2011.

In a group, "you're as efficient as the least efficient doctor," he says. "You can't make quick changes in the practice, such as adopting new technology to make the practice more efficient," because less tech-savvy physicians would oppose those changes.

As a solo physician, he feels more engaged with his work, he says. He's seeing just as many patients as he did in the group, but his income is significantly higher because his revenue is higher and his overhead is lower.

The problem of physicians disengaged from their work is an increasing concern for executives in large organizations, especially health systems.

Although employed physicians are usually still engaged with their work, they are less likely to be engaged with their organizations, according to a 2014 survey[7] by Physician Wellness Services and Cejka Search. The survey found that 64.2% scored in the high range on engagement with their work, but only 41.5% scored similarly on engagement with their organization.

Disengagement between physicians and organizations could become even more of a problem as hospitals plan tighter relationships with their physicians in accountable care organizations, bundled payments, and other value-based arrangements.

The extent of physicians' disengagement with organizations came to light in the Bain survey. That survey measured employed physicians' "net promoter score"—that is, the percentage of physicians who promoted the organization compared with those who devalued it. Bain found that physicians in management-led organizations had a score of -13, compared with a score of +19 of those in physician-led organizations.

A vast rift exists between employed physicians and management, according to the 2016 Jackson Healthcare survey. In that survey, only 46% of hospital-employed physicians said the hospital treats them fairly, 48% said the hospital always treats them with respect, and 45% said hospital leadership honors its promises.

Communication between the two groups is weak. Only 34% of hospital-employed physicians and 43% of hospital executives said they were satisfied with the level of communication, Jackson Healthcare found Furthermore, only 26% of physicians said that they were involved in administrative decision-making.

Hospitals have to start owning the problem, according to Robert M. Stark, MD, a Connecticut internist who advises Physicians Wellness. "Administrators need to understand that engagement is won, not demanded," he wrote in the announcement of the Cejka-Physicians Wellness survey.

Traditionally, physicians interact with management through the organized medical staff (OMS), but this model has become antiquated, according to a 2014 article[8] in Health Affairs coauthored by Francis J. Crosson, group vice president for physician satisfaction, care delivery, and payment at the American Medical Association (AMA).

Crosson and his coauthor, John Combes, wrote that the OMS model worked well when most physicians on staff were self-employed, but it's ill-equipped to deal with the much greater communication needs of employed physicians. The model lacks full-time leadership with the expertise needed to talk to hospital management, they explained.

Today, the OMS has to be "capable of accountable self-governance, collective management of quality and cost, the ability to create and award incentives, and the ability to share in the overall organization's operational management," Crosson and Combes wrote.[8]

Stakeholders discussed changing the OMS model at a meeting convened in October 2013 by the AMA, the American Hospital Association, and Health Affairs, the article reported. Many attendees felt that more employed physicians from the front line should fill leadership positions, according to the authors.

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